Forms and brochures
A list of our forms and brochures.
It is better to contact us before you apply for assistance. That way we can learn about your circumstances and talk to you about the types of assistance you might get.
Our forms and brochures are in RTF, MS Word, or PDF format. You will need Adobe Acrobat Reader to view PDF files. This can be downloaded for free at the Adobe website.
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A
Accommodation Supplement Application Form [PDF, 316.82KB]
Application for New Zealand Payment Overseas [PDF, 87.5KB]
Appointment of an Agent Form [PDF, 123.73KB]
Are you a carer? [PDF, 90.41KB]
Do you know that Work and Income can help you financially? You may be able to get Domestic Purposes Benefit – Care of Sick or Infirm.
Are you going overseas? [PDF, 483.46KB]
A guide to what happens with your income support if you are going overseas.
Also available in [RTF 118KB]Are you starting work? [PDF, 159.39KB]
Find out how we can help through In Work Support.
Also available in [RTF 65KB]B
Bank automatic payment form [PDF, 100.36KB]
Benefit rates table 1 April 2009 [RTF, 344.8KB]
Benefit rates table valid at 1 April 2009.
C
Change of bank account form [PDF, 80.15KB]
Child Disability Allowance Application Form [PDF, 134.76KB]
Child Disability Allowance Medical Certificate [PDF, 96.91KB]
Child Inclusion Form [PDF, 102.32KB]
Complete this form if you’d like to have a child included in your benefit.
Childcare & OSCAR Subsidy - Change of Circumstances Form [PDF, 87.24KB]
Childcare & OSCAR Subsidy Application Form [PDF, 237.59KB]
Childcare Subsidy Verification Form [PDF, 70.92KB]
Civil Defence Payments to Evacuees Application Form [PDF, 89.84KB]
Civil Defence Payments to Hosts Application Form [PDF, 81.09KB]
Civilian Amputee Assistance Application Form [PDF, 143.91KB]
Community Services Card [PDF, 299.2KB]
How a Community Services Card can help you with the costs of health care.
Also available in [RTF 96KB]Community Services Card Application Form [PDF, 138.42KB]
Continuation of the Rural Assistance Payment Application Form [PDF, 76.19KB]
D
Disability Allowance - Counselling Form [PDF, 83.7KB]
Disability Allowance - Medical Alarm Costs Self-Assessment Form [PDF, 62.01KB]
Disability Allowance Application Form [PDF, 316.82KB]
Disability Allowance Application Form (for clients already receiving Work and Income assistance) [PDF, 114.66KB]
Disability Certificate [PDF, 83.84KB]
Disability assistance [PDF, 223.94KB]
A guide about the Disability Allowance, Special Disability Allowance, Modification Grant and the Child Disability Allowance.
Also available in [RTF 86KB]Domestic Purposes Benefit - Care of Sick or Infirm Application Form [PDF, 241.35KB]
Domestic Purposes Benefit - Care of Sick or Infirm Medical Certificate [PDF, 117.42KB]
Domestic Purposes Benefit Application Form - Sole Parents [PDF, 283.93KB]
Domestic Purposes Benefit Application Form - Women Alone [PDF, 175.03KB]
Domestic Purposes Benefit Caring for Sick or Infirm (DPB - CSI) - Carer Statement [Word, 93KB]
The Carer Statement is an application form that is part of the assessment process for retrospective applications for Domestic Purposes Benefit - Care of Sick or Infirm.
Also available in [RTF 895KB]Domestic Purposes Benefit Caring for Sick or Infirm (DPB - CSI) Retrospection factsheet [RTF, 53.45KB]
Domestic purposes and widow's benefits [PDF, 210.64KB]
Financial assistance for sole parents, some women living alone and caregivers.
Also available in [RTF 132KB]E
Early Learning Payment Application Form [PDF, 290.97KB]
Emergency Benefit Application Form [PDF, 341.92KB]
Emergency Maintenance Allowance Application Form [PDF, 190.04KB]
Extra Help Application Form [PDF, 316.82KB]
Extra help for people receiving New Zealand Superannuation or Veteran's Pension factsheet [PDF, 137.56KB]
Also available in [RTF 96KB]
F
Financial assistance for live organ donors [PDF, 214.38KB]
Financial assistance for people donating a kidney or liver tissue for transplant within New Zealand
Also available in [RTF 62KB]Financial assistance in a pandemic [PDF, 158.01KB]
The financial assistance Work and Income may be able to assist you and your family if you have been affected by a pandemic ( such as the current Influenza A (H1N1) pandemic).
Financial assistance when you're having a baby [PDF, 230.19KB]
Help available if you're having a baby.
Also available in [RTF 60KB]Find a job build a future [PDF, 967.74KB]
Tools to help you find work JOBSW0007 NOV 2009 Contents 3 Starting your job search 5 Writing your CV 6 Two main ways to set out your CV 7 Cover letter tips 8 Cover letter example 9 Finding job leads 10 Job leads diary 11 Following up job leads 13 Applying for a job 15 Preparing for an interview 16 Some typical questions an employer may ask 16 When you get the job 17 Searching for a job on the Internet 18 Transitioning into Work 18 In Work Support 19 Financial help 3FINd A JOB BuIld A FuTure Starting, To find job ads: Check the newspapers, community papers, local noticeboards and radio job lines use Internet job services Contact employment agencies To find your own leads: Ask friends, family and other contacts if they know of any jobs going Find employers in the yellow pages and phone or visit them Place job wanted adverts in the paper read the business pages and tenders columns of the papers to find new or growing businesses that might have jobs Tips for checking job sites read all the, E X AM P L E JOB APPLICATION Position details Position applied for: Storeperson Reference no.: 3461 Personal details Name of applicant: First name: Len Last name: Morrison Address: The Road, Taupo Phone: Home: 123-4567 Work: n/a Mobile: 027 112233 Education Highest qualication: School C School/university/polytechnic: Taupo High School Year qualication gained: 1996 Work history Please state your work history starting with the most recent job Job title: Retail Assistant Company: ABC Products Responsibilities: Customer service, cash handling, stocking shelves
Finding job leads worksheet [PDF, 148.88KB]
Tips on how to go about finding job leads and making contact with employers.
Also available in [RTF 106KB]Funeral Grant Application Form [PDF, 112.02KB]
Funeral Grant factsheet [PDF, 136.91KB]
Help with some of the funeral costs of someone close to you who has died.
Funeral Grant factsheet [RTF, 61.16KB]
G
Getting Netherlands pensions in New Zealand [PDF, 169.29KB]
Answers to questions about getting Netherlands pensions in New Zealand.
Also available in [RTF 102KB]Getting United Kingdom pensions in New Zealand [PDF, 168.56KB]
Answers to questions about getting United Kingdom pensions in New Zealand.
Also available in [RTF 107KB]Getting in touch with us [PDF, 105.59KB]
Find the easiest way for you to contact us.
Also available in [RTF 101KB]Getting work skills and experience [PDF, 403.46KB]
Training and subsidies to help you get the job you want.
Also available in [RTF 59KB]Going Overseas factsheet [RTF, 93.81KB]
H
Help for kinship carers [PDF, 405.43KB]
A guide for people who are raising someone else's child.
Also available in [RTF 129KB]Help when you're working [PDF, 307.7KB]
A guide for people who are working or starting work
Also available in [RTF 162KB]Help with childcare costs [PDF, 270.83KB]
A guide for parents and caregivers about assistance which helps with childcare costs.
Also available in [RTF 116KB]Home Help Payments Application Form [PDF, 133.75KB]
Housing Modification Grant - Income and asset details [PDF, 83.97KB]
How can we help you [PDF, 197.8KB]
A quick guide to the support you and your family may be able to get from us.
Also available in [RTF 165KB]How to avoid benefit fraud [PDF, 350.63KB]
How you can get your correct entitlement and avoid benefit fraud by keeping us up to date with your personal situation.
Also available in [RTF 56KB]I
Income Tested Superannuation Fact Sheet [PDF, 134.77KB]
Information concerning income tested superannuation.
Independent Youth Benefit [PDF, 210.64KB]
A weekly payment which helps 16 and 17 year-olds who can't live with their parents and are not supported by them or anyone else.
Also available in [RTF 70KB]Independent Youth Benefit Application Form [PDF, 178.87KB]
Information Matching [PDF, 51.16KB]
A guide to how we match records to find benefit fraud.
Also available in [RTF 42KB]International Custody Dispute Payment Application Form [PDF, 182.84KB]
International Custody Dispute Payment factsheet [PDF, 58.57KB]
Also available in [RTF 55KB]
International Social Security Agreements [PDF, 95.28KB]
A guide to New Zealand's social security agreements with other countries.
Also available in [RTF 72KB] Dutch [PDF 96KB], [RTF 79KB]Invalid's Benefit [PDF, 218.81KB]
A guide for people with a permanent injury, sickness or disability.
Also available in [RTF 88KB]Invalid's Benefit Application Form [PDF, 341.53KB]
L
Limited Service Volunteer (LSV) [PDF, 924.3KB]
A six-week motivational course run by the New Zealand Defence Force.
Also available in [RTF 54KB]Living Alone Payment Application Form [PDF, 100.44KB]
M
Making a complaint [PDF, 75.19KB]
How to make a complaint.
Managing your money [RTF, 134.87KB]
What it means to have a budget.
Managing your money [PDF, 327.39KB]
Missionary work, volunteer services abroad work and presence factsheet [RTF, 68.88KB]
How voluntary or humanitarian work affects your pension entitlements.
N
Need extra help with costs [PDF, 311.52KB]
A guide to allowances and extra payments for people on a benefit.
Also available in [RTF 131KB]New Zealand Superannuation [PDF, 300.2KB]
Financial assistance for people aged 65 years or more.
Also available in [RTF 84KB]New Zealand Superannuation Application Form [PDF, 336.08KB]
New Zealand Superannuation Application Form - Partner [PDF, 297.41KB]
O
OSCAR Subsidy - Additional school holiday programme application form [PDF, 74.88KB]
The application form to use if you are applying for an OSCAR Subsidy and your child is attending more than one programme during the school holidays.
OSCAR Subsidy Verification Form [PDF, 69.11KB]
OSCAR programmes and OSCAR Subsidy [PDF, 235.71KB]
A quick guide about OSCAR programmes and OSCAR Subsidy.
Also available in [RTF 55KB] Maori [PDF 252KB], [RTF 59KB]Obligations - Child Disability Allowance [PDF, 56.96KB]
Obligations - Childcare Subsidy [PDF, 40.49KB]
Obligations - Childcare Subsidy - Partner [PDF, 37.8KB]
Obligations - Domestic Purposes Benefit - Care of Sick or Infirm [PDF, 50.89KB]
Obligations - Domestic Purposes Benefit - Care of Sick or Infirm - Partner [PDF, 48.05KB]
Obligations - Domestic Purposes Benefit - Sole Parent [PDF, 60.06KB]
Obligations - Domestic Purposes Benefit - Woman Alone [PDF, 59.08KB]
Obligations - Extra Help [PDF, 40.24KB]
Obligations - Extra Help - Partner [PDF, 37.89KB]
Obligations - Independent Youth Benefit [PDF, 60.31KB]
Obligations - Invalids Benefit [PDF, 51.89KB]
Obligations - Invalids Benefit - Partner [PDF, 73.77KB]
Obligations - Sickness Benefit [PDF, 52.87KB]
Obligations - Sickness Benefit - Partner [PDF, 74.98KB]
Obligations - Unemployment Benefit [PDF, 52.3KB]
Obligations - Unemployment Benefit - Partner [PDF, 74.47KB]
Obligations - Widows Benefit [PDF, 59.49KB]
Orphan's and Unsupported Child's Benefit [PDF, 256.63KB]
A guide for caregivers who are raising someone else's child
Also available in [RTF 77KB]Orphan's and Unsupported Child's Benefit Application Form [PDF, 126.42KB]
Other income you earn factsheet [PDF, 76.92KB]
What you need to know if you get other income and financial assistance from us.
Also available in [RTF 57KB]Our services and standards [PDF, 178.05KB]
A guide to the services we offer and what you can expect from us.
Also available in [RTF 106KB]P
PACE 2008 resource pack [PDF, 227.49KB]
Resource pack containing information about assistance and funding available for people who are looking for work in the arts and cultural sector. Also available in [RTF 6.59MB], [Word 770KB]
Pacific Earthquake/Tsunami factsheet [PDF, 157.05KB]
Pacific Earthquake/Tsunami factsheet - Samoan [PDF, 177.48KB]
Pacific Earthquake/Tsunami factsheet - Tongan [PDF, 228.07KB]
Parent's Income Verification for Sickness Benefit or Emergency Maintenance Allowance Form [PDF, 123.01KB]
Payment options for overseas pensions [PDF, 332.3KB]
A guide for people who qualify for a pension from the United Kingdom, the Netherlands, Australia, Jersey, Guernsey, or the Republic of Ireland.
Also available in [RTF 90KB]R
ReStart Application Form [PDF, 163.89KB]
ReStart Factsheet [PDF, 78.71KB]
Help for people who have been made redundant.
Also available in [RTF 79KB]Redundancy services for employees [PDF, 235.62KB]
Reimbursement of Health Overcharges Application form [PDF, 116.66KB]
Relationships and income assistance [PDF, 381.79KB]
Things you need to know about relationships when getting income assistance.
Also available in [RTF 57KB]Repayment Authority Form [PDF, 123.32KB]
This form provides you with different options on how you can repay Work and Income.
Residency requirements for New Zealand benefits and pensions factsheet [RTF, 73.98KB]
Residential Care Loans factsheet [PDF, 67.79KB]
Helps older people who can’t get Residential Care Subsidy to pay for the cost of their contracted care services.
Residential Care Loans factsheet [RTF, 47.76KB]
Residential Care Subsidy [PDF, 815.85KB]
Financial assistance for people in rest homes or hospital.
Also available in [RTF 131KB]Retired and going overseas [PDF, 280.92KB]
A guide to receiving New Zealand Superannuation or the Veteran's Pension overseas.
Also available in [RTF 151KB]Review Rights and Responsibilities flyer [PDF, 81.17KB]
Information concerning your rights and responsibilities in dealing with Work and Income.
Review of Decision Application Form [PDF, 247.75KB]
Rural Assistance Payment Application Form [PDF, 164.45KB]
Rural assistance payments [PDF, 88.61KB]
A payment to meet the essential living expenses of farming families affected by an adverse event such as a flood, drought or other natural disaster.
Also available in [RTF 102KB]S
Seasonal work [PDF, 279.66KB]
Finding seasonal work and how we may be able to help.
Also available in [RTF 71KB]Services for Deaf, Hearing Impaired and Speech Impaired people [PDF, 70.23KB]
We have a centralised team who can quickly respond to the deaf or those who have hearing or speech impairments.
Sickness Benefit [PDF, 268.03KB]
A guide to the sickness benefit which helps people who aren't currently working, or are working less hours, because they are sick, injured, disabled or pregnant.
Also available in [RTF 74KB]Sickness Benefit Application Form [PDF, 357.18KB]
Social security agreement with Australia [PDF, 615.37KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or Australia.
Also available in [RTF 229KB]Social security agreement with Canada [PDF, 683.27KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or Canada
Also available in [RTF 170KB]Social security agreement with Denmark [PDF, 796.06KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or Denmark.
Also available in [RTF 188KB]Social security agreement with Greece [PDF, 695.89KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or Greece.
Also available in [RTF 184KB]Social security agreement with Ireland [PDF, 699.43KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or Ireland.
Also available in [RTF 190KB]Social security agreement with Jersey or Guernsey [PDF, 763.23KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand, Jersey or Guernsey.
Also available in [RTF 194KB]Social security agreement with the Netherlands [PDF, 671.33KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or the Netherlands.
Also available in [RTF 215KB]Social security agreement with the United Kingdom [PDF, 316.08KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or the United Kingdom.
Also available in [RTF 180KB]Social security arrangements with Pacific countries [PDF, 533.83KB]
A guide for getting benefits or pensions if you have lived, live or are going to live in New Zealand or in any of the listed Pacific countries.
Also available in [RTF 114KB]Special Banking Option Australia - Acceptance Form [PDF, 998.75KB]
Special Banking Option Australia - Bank Account Application Form [PDF, 187.72KB]
Special Banking Option Australia - Information Release Form [PDF, 338.98KB]
Special Banking Option Factsheet [PDF, 73.69KB]
The Special Banking Option (SBO) enables you to receive overseas and New Zealand benefits or pension payments as one regular payment
Also available in [RTF 62KB] Maori [PDF 103KB], [RTF 79KB]Special Banking Option Ireland - Acceptance Form [PDF, 676.83KB]
Special Banking Option Ireland - Bank Account Application Form [PDF, 189.29KB]
Special Banking Option Ireland - Information Release Form [PDF, 342.91KB]
Special Banking Option Jersey and Guernsey - Acceptance Form [PDF, 951.5KB]
Special Banking Option Jersey and Guernsey - Bank Account Application Form [PDF, 373.98KB]
Special Banking Option Jersey and Guernsey - Information Release Form [PDF, 313.19KB]
Special Banking Option Netherlands - Acceptance Form [PDF, 219.72KB]
Special Banking Option Netherlands - Bank Account Application Form [PDF, 156.09KB]
Special Banking Option Netherlands - Information Release Form [PDF, 718.17KB]
Special Banking Option UK - Acceptance Form [PDF, 445.9KB]
Special Banking Option UK - Bank Account Application Form [PDF, 214.35KB]
Special Banking Option UK - Information Release Form [PDF, 176.2KB]
Start your own business [PDF, 323.86KB]
Some things to think about first.
Also available in [RTF 99KB]Starting your job search worksheet [PDF, 33.18KB]
Help starting your job search and planning your career.
Also available in [RTF 89KB]T
Taking your New Zealand Superannuation or Veteran's Pension to the Pacific [PDF, 88.05KB]
A guide to getting your New Zealand Superannuation or Veteran’s Pension when you move to certain Pacific countries.
Also available in [RTF 67KB] Cook Island Maori [PDF 127KB], [RTF 76KB] Samoan [PDF 123KB], [RTF 110KB] Tongan [PDF 143KB], [RTF 84KB]Testing and review of overseas benefit or pension entitlements factsheet [RTF, 57.39KB]
A guide to how your, or your spouse or partner's, entitlements to overseas benefits or pensions affect your New Zealand benefit or pension.
The Great Little Cookbook [PDF, 1.06MB]
The Great Little Cookbook - hints and healthy eating on a tight budget.
Also available in [RTF 283KB]Training Incentive Allowance Application Form [PDF, 123.19KB]
Training Incentive Allowance factsheet [PDF, 72.8KB]
Also available in [RTF 50KB]
Training Statement [PDF, 75.28KB]
Transition to Work Grant Application Form [PDF, 152.48KB]
Treatment of overseas pensions or benefits in New Zealand factsheet [PDF, 181.23KB]
How your overseas pensions or benefits is treated in New Zealand.
Also available in [RTF 77KB]U
Unemployment Benefit [PDF, 268.32KB]
A guide for people who are out of work.
Also available in [RTF 80KB]Unemployment Benefit Application Form [PDF, 357.94KB]
Unemployment Benefit Re-Application Form [PDF, 131KB]
W
War Veterans' Entitlements [PDF, 305.72KB]
A guide to the War Disablement, Surviving Spouse or Partner and Veteran’s pensions.
Also available in [RTF 105KB]Widows Benefit Application Form [PDF, 182.07KB]
Writing your CV worksheet [PDF, 39.82KB]
Some guidelines to follow when writing your CV.
Also available in [RTF 82KB]Y
Young Parent Childcare Payment Application Form [PDF, 158.44KB]
Young Parent Childcare Payment brochure [PDF, 857.85KB]
A payment which helps parents aged under 18 years who need support to pay childcare costs while they attend secondary school.